Common Misconceptions About Psychotherapy

Some ideas about therapy appear so frequently in fiction that I wonder how many writers are using them deliberately and how many simply don’t realize they’re inaccurate. Here are six of the most common, along with some information on the most standard current practice.

1. You lie on a sofa

Fact: Therapy clients don’t lie on a couch; some therapists’ offices don’t even have diapers.

So where did this come from? Sigmund Freud had his patients lie down on a sofa so that he could sit in a chair behind their heads. Because? There’s no deep psychological reason, he just didn’t like people looking at him.

There are many reasons why modern therapy clients would not be happy about this. Imagine telling someone about difficult or embarrassing experiences and not only not being able to see them, but they react with silence. Why the hell would you want to go back?

The ideal therapeutic setup, and they actually teach this in graduate school, is to have both chairs turned inward at about a 20 degree angle (plus or minus 10 degrees), usually with 8 or 10 feet between them. Often the therapist and client end up facing each other because they turn toward each other in their chairs, but with this setup, the client doesn’t feel confrontational.

Even if there is a couch in the room, the therapist’s chair will almost invariably be turned at an angle to it.

2. Therapists analyze everyone

Fact: Therapists don’t analyze people any more than the average person, and sometimes less frequently.

Ironically, only people trained in Freud’s approach of making the patient lie down on the couch and free-associating about the mother (also known as psychoanalysis) are taught to analyze. All other therapists are taught to understand why people do things, but it takes a lot of energy to understand people. And to be very frank, while therapists are often caring people who want to help their clients, in everyday life they are dealing with their own problems and don’t necessarily have the time or space to worry about the problems of others. golden behaviours.

And the last thing most therapists want to hear about in their spare time is strangers’ problems. Therapists are paid to treat other people’s problems for a reason!

3. Therapists have sex with their clients.

Fact: Therapists never, ever, ever have sex with their clients, or with clients’ friends or family members, if they want to keep their licenses.

That includes sex therapists. Sex therapists don’t watch their clients have sex or ask them to experiment in the office. Sex therapy is often about educating and addressing relationship issues, as those are two of the most common reasons people have sexual problems.

Therapists are also not supposed to have sexual relationships with former clients. The rule is that if two years have passed and the prior client and therapist meet and somehow hit it off (i.e. this was not planned), the therapist will not be expelled from professional organizations or have their licenses revoked. . But in most cases, other therapists will continue to view them as suspects.

The reasoning behind this is simple: therapists must listen and help without involving their own problems or needs, which creates a power differential that is difficult to overcome.

And, truth be told, the roles that therapists play in their offices are just facets of who they really are. Therapists focus their full attention on clients without ever complaining about their own worries or insecurities.

When people think they want to be friends, they usually want to be friends with the therapist, not with the person, and true friendship involves sharing power and flaws, and caring for each other to some degree. Getting to know a therapist as a real person can be disappointing, because now they want to talk about themselves and their own problems!

4. It’s about your mother (or childhood, or the past…)

Fact: One branch of psychotherapeutic theory focuses on childhood and the unconscious. Not the rest.

Psychodynamic theory upheld Freud’s psychoanalytic belief that early childhood and unconscious mechanisms are important to later problems, but most modern professionals know that we are exposed to many influences in everyday life that are just as important.

Some therapists will tell you outright that your past isn’t important if it isn’t directly relevant to the current problem. Some believe that extensive discussion about the past is an attempt to escape responsibility (Gestalt therapy) or to avoid actively working to change (some types of cognitive behavioral theory). Some believe that the social and cultural environments we live in today are what cause problems (systems, feminist and multicultural therapies).

5. ECT is painful and is used to punish bad patients

Fact: Electroconvulsive treatment (formerly called electroshock treatment) is a rare treatment of last resort for clients who have been in and out of the hospital due to suicidal tendencies, and for whom more traditional treatments, such as medications, do not they have not worked. In some cases, the client is so depressed that they cannot do the work to get better until their brain chemistry is working more effectively.

When considering ECT, some clients are eager to try it. They’ve tried everything else and just want to feel better. When death feels like your only other option, having someone pass a painless current through your brain while you sleep doesn’t seem like such a bad idea.

ECT is not painful, nor does it make you nervous or shaky. Patients are given a muscle relaxant, and since it is scary to feel paralyzed, they are also briefly placed under general anesthesia. The electrodes are usually attached to only one side of the head, and current is delivered in short pulses, causing a grand mal seizure. Doctors monitor electrical activity on a screen.

A seizure causes the brain to produce and use serotonin, norepinephrine, and dopamine, all brain chemicals that are low when someone is depressed. Some people wake up feeling like a miracle has happened. Multiple sessions are usually required to maintain the changes, and the individual may then be switched to antidepressants and/or other medications.

ECT is no more dangerous than any other procedure administered under general anesthesia, and many of the potential side effects (confusion, memory impairment, nausea) can be as much a result of the anesthesia as the treatment itself.

6. “Schizophrenia” is the same as having “multiple personalities”

Fact: Schizophrenia is a biological disorder with a genetic basis. It usually causes hallucinations and/or delusions (strong ideas that go against cultural norms and are not supported by reality), along with a deterioration in normal day-to-day functioning. Some people with schizophrenia periodically become catatonic, have paranoid thoughts, or behave in a disorganized manner. They may speak in strange ways, becoming tangential (verbally rambling, often in a way that doesn’t make sense to the listener), using nelogisms (made up words), metallic sound associations (rhymes), or, in extreme cases, producing word salads. (sentences that sound like a bunch of confusing words and may or may not be grammatically correct).

Dissociative identity disorder (formerly multiple personality disorder) is caused by trauma. In some abuse situations, the normal defense mechanism of dissociation can be used to “split” the memories of the trauma. In DID, the split also includes the part of the “core” personality attached to that memory or series of memories. The dissociated identity often has its own name, traits, and quirks; and may or may not age at the same rate as the rest of the personality (or personalities), if at all.

Therefore, referring to oneself as “schizoid” or “schizoid” or “schizophrenic” when one means one has alter egos or contradictory personality traits makes no sense (and is guaranteed to make psychology experts wonder! shudder)!